STIFFNESS and swelling were identified as the most reliable clinical indicators distinguishing psoriatic arthritis from non-inflammatory musculoskeletal conditions in patients with psoriasis, according to a retrospective review from a combined rheumatology-dermatology clinic.
Psoriatic arthritis is a chronic inflammatory disorder affecting both axial and peripheral joints that can significantly impact patient quality of life. However, accurate diagnosis remains challenging due to symptom overlap with more common non-inflammatory conditions such as osteoarthritis, tendonitis, and mechanical joint pain. This study sought to better define alternative diagnoses in psoriasis patients initially referred for suspected psoriatic arthritis.
Investigators conducted a chart review of 242 patients seen at a tertiary combined clinic between November 2019 and March 2022. Of these, 34 patients with psoriasis were referred specifically for evaluation of possible psoriatic arthritis. Each underwent detailed rheumatologic assessment, including clinical history, physical examination, and supporting laboratory or imaging studies as required.
The findings revealed that 14 of the 34 patients (41.2%) were ultimately diagnosed with non-inflammatory musculoskeletal conditions rather than psoriatic arthritis. The most common alternative diagnosis was mechanical joint pain. Crucially, the presence of stiffness and swelling was significantly more common among those with confirmed psoriatic arthritis, underscoring the diagnostic value of these clinical features.
The authors note that this distinction is essential to prevent both misdiagnosis and inappropriate management. Enhanced clinician awareness and education on differentiating non-inflammatory musculoskeletal pain from psoriatic arthritis may improve diagnostic accuracy and optimize referrals from dermatology to rheumatology.
These results reinforce the importance of comprehensive evaluation of musculoskeletal complaints in patients with psoriasis. Recognizing stiffness and swelling as key red flags for psoriatic arthritis could support earlier diagnosis, targeted treatment, and improved long-term outcomes.
Reference:
Odega UK et al. Characterising Alternative Diagnoses to Psoriatic Arthritis in a Rheumatology-Dermatology Combined Clinic. Australas J Dermatol. 2025. doi: 10.1111/ajd.14585
